The misdirected narrative around Nigeria’s HIV response: Are we ready to change it?, By Adaeze Oreh

We have spent decades learning how to treat HIV. In 2026, Nigeria must show that prevention can also be practical, visible and accessible. The country’s success should be measured not by the number of strategies announced or medicines introduced, but by whether an ordinary Nigerian, regardless of income, age or location, can obtain the tools needed to avoid HIV in the first place.

This week, the Executive Director of the Global Fund to Fights AIDS, TB and Malaria, Peter Sands stated that progress against these diseases is on a knife-edge, with focus on treatment to the detriment of prevention. Several months ago, Nigeria’s news cycle was awash with headlines such as “Lagos tops Nigeria’s HIV burden as new infections hit 102,025”, and “Lagos, Benue Top HIV Burden As Nigeria Records 20,838 New Infections In Q1 2026.” It wasn’t long before every social media channel had influencers, commentators, and general analysts turning on their ring lights and pushing posts and content speaking to how Lagos is the headquarters of HIV in Nigeria. As I saw reel after reel, and feed post after post re-echoing the same narrative, I shook my head. Why? Because once again, sensational headlines had caused us to completely lose the plot. Yet again, it was exactly one year ago that spookily similar headlines had circulated about Rivers State.

So, why should our focus be redirected whenever these HIV statistics are released? Sit tight and let me explain.

In December 2020, the Joint United Nations Programme on HIV/AIDS (UNAIDS) released a new set of ambitious targets calling for 95 per cent of all people living with HIV to know their HIV status, 95 per cent of all people with diagnosed HIV infection to receive sustained antiretroviral therapy, and 95 per cent of all people receiving antiretroviral therapy to have viral suppression by 2025. This was then adopted by United Nations Member states in June 2021 as part of the new Political Declaration on HIV and AIDS. These targets were to bring about a paradigm shift through targeted primary prevention, by bridging inequalities in treatment coverage and outcomes and accelerating reductions in new HIV infections across sub-populations, age groups and geographic settings.

Recent national data from the National Agency for the Control of HIV and AIDS (NACA) reveal that with approximately two million people living with HIV in Nigeria, 87 per cent of them know their status, 98 per cent of those who know their status are on life-saving treatment, and 95 per cent of those on treatment have achieved viral suppression (and therefore cannot transmit HIV). Over the last 25 years, the country has consistently improved HIV screening, care and treatment, and those results, while deserving of recognition, need to be reframed in how they are projected. In the last decade, Nigeria has recorded a 46 per cent decline in new HIV infections, more people living with HIV now know their status, receive treatment regularly and are no longer transmitting the virus.

What this essentially means is that the next time HIV burden data is splashed across our headlines and our screens, the question should not be which state is the country’s HIV capital, but rather, where is it most likely that those infected actually know that they are, have access to treatment, and are actually taking it. The current messaging about HIV burden unfortunately risks allowing many people in states outside of Lagos, Benue, Rivers and Akwa Ibom to underestimate their vulnerability.

In late 2023, NACA reported an astonishing 1,400 new HIV infections and 50,000 AIDS-related deaths weekly. That alarming rate of HIV transmission was reportedly largely among children, with 22,000 new infections recorded amongst those aged 0–14 years. Presently, Nigeria accounts for 25 per cent of the global mother-to-child transmission of HIV.

The major risk factors for mother-to-child transmission of HIV include communities with limited access to antiretroviral treatment (ART), maternal high viral load or untreated infections; where ART is not administered to exposed infants; and post-natal dropout where mothers do not follow up after delivery and therefore risk stopping ART and transmitting the virus to their babies during the breastfeeding period. From recent data, post-natal dropout accounts for 60 per cent of new child infections. Another factor is mixed feeding, where combining breastfeeding with other feeds in the first six months of the infant’s life increases transmission risk. All these are significantly driven by stigma and prejudice, and highlight issues around equitable access to testing, care and treatment.

While Nigeria has made strong progress in HIV testing and treatment, its most urgent challenge is preventing new infections by ensuring that prevention tools reach the people who need them most, where they are, and exactly when they need them. According to the Director-General of NACA, Dr Temitope Ilori, nine out of ten new adult HIV infections now occur among “ordinary Nigerians” – the general population outside traditionally prioritised high-risk groups…

The transmission of HIV among the general populace shows distinct vulnerabilities, with heterosexual transmission responsible for up to 80 per cent of new infections due to unprotected heterosexual intercourse, primarily sustained by multiple sexual partnerships and low rates of consistent condom use. Additionally, young people, particularly adolescent girls and young women aged 15–24, are more than three times as likely to be living with HIV as young men of the same age, driven by gaps in modern sex education, economic vulnerabilities, and limited risk awareness. Furthermore, the virus does not circulate evenly across the country, and high populations, mobility, and historical structural gaps contribute to its spread.

It is not coincidental that much of the gains achieved in Nigeria’s HIV response over the past twenty-plus years occurred amid substantial international donor funding. Since 2003, the US government, through PEPFAR, has invested more than $85 billion in the global HIV/AIDS response and saved more than 17 million lives in 54 countries, including Nigeria, where it has invested over $6 billion. All those gains are currently sadly jeopardised by recent US funding cuts. Among 70 UNAIDS country offices, 40 per cent reported that community-led services had been stopped due to those cuts, and stock levels of commodities were massively depleted.

Better Prevention Tools Mean Little Without Access

While Nigeria has made strong progress in HIV testing and treatment, its most urgent challenge is preventing new infections by ensuring that prevention tools reach the people who need them most, where they are, and exactly when they need them. According to the Director-General of NACA, Dr Temitope Ilori, nine out of ten new adult HIV infections now occur among “ordinary Nigerians” – the general population outside traditionally prioritised high-risk groups (commercial sex workers, men who have sex with men, and injection drug users). Prevention messaging must adapt to reflect this reality so that people do not underestimate their risk.

Addressing this requires a multi-pronged approach:

Location and Outreach: The National HIV and AIDS Strategic Plan (2026–2030) shifts focus toward youth, behavioural change, and community-based prevention through schools, religious institutions and communities, moving beyond clinical settings.

Innovation and Accessibility: Real-time prevention depends on steady access to condoms, stigma-free testing, and pre-exposure prophylaxis (PrEP) in rural and underserved areas, and not just during one-off outreach campaigns. Innovations such as Lenacapavir (a twice-yearly injectable PrEP) offer convenient alternatives to daily pills, which is offered with a rebate for now, but variable and high private costs reaching up to ₦360,000 (nearly $250) threaten equitable access. Procurement and distribution must prioritise public need over purchasing power. Additionally, closing gaps in mother-to-child transmission targets remains critical. Every pregnant woman should be able to receive timely HIV testing, treatment and follow-up care, regardless of where she lives. From the evidence, preventing babies from acquiring HIV is one of the clearest measures for reducing new childhood infections.

The country’s HIV response should neither be judged as an unmitigated success nor as a failure. Nigeria’s current 95-95-95 achievements show that progress is possible. However, existing prevention gaps show that progress can be incomplete. HIV prevention in today’s Nigeria will not succeed if it remains confined to clinics and periodic public-health campaigns.

Sustainable Domestic Financing: Long-term progress cannot rely on uncertain international aid. When US funding cuts were suddenly announced in late January 2025, Rivers State suddenly had over 900 trained HIV response personnel out of work. This was cushioned by their inclusion in the employment of over 2,000 healthcare workers by the state government. For other states whose donor-funded workforce was as large as 22,000, the state response would have been significantly more challenging. These differences highlight the necessity of domestic financing, state-level commitments, and integrating HIV care into primary healthcare systems to support health workers and supply chains and reduce stigma.

Reframing Media and Public Messaging: Media reporting must shift from highlighting raw infection numbers to tracking coverage – the percentage of people who know their status, receive treatment, and achieve viral suppression. This demonstrates the strength of a state’s surveillance system, expanded access to HIV services, and sustained progress towards epidemic control. Focusing only on detected cases obscures the threat in ‘blissfully ignorant’ states with sub-optimal testing, where low coverage creates a false sense of security. There is a saying that, “What you don’t know can’t hurt you.” With HIV/AIDS, it most certainly can.

The Real Measure of Success Is What Happens Next

Ultimately, turning strategic advantages into lasting progress requires sustained investment in community health, affordable commodities, youth-friendly services, and accurate public education embedded within a resilient, stigma-free, and equitable health system.

The country’s HIV response should neither be judged as an unmitigated success nor as a failure. Nigeria’s current 95-95-95 achievements show that progress is possible. However, existing prevention gaps show that progress can be incomplete. HIV prevention in today’s Nigeria will not succeed if it remains confined to clinics and periodic public-health campaigns. The central question is whether Nigeria can build on its treatment achievements while giving prevention the same political attention, financial commitment and operational discipline.

We have spent decades learning how to treat HIV. In 2026, Nigeria must show that prevention can also be practical, visible and accessible. The country’s success should be measured not by the number of strategies announced or medicines introduced, but by whether an ordinary Nigerian, regardless of income, age or location, can obtain the tools needed to avoid HIV in the first place.

Adaeze Oreh, a professor, is also a Kofi Annan Global Health Leadership Fellow, Senior Fellow Aspen Global Innovators, Amujae Leader, consultant family physician, public health expert and advocate for affordable universal healthcare for all Nigerians. She teaches at PAMO University of Medical Sciences in Port Harcourt and was the 27^th Honourable Commissioner for Health in Rivers State, Nigeria.